在疑似急性尾炎的儿童中,补充计算机断层扫描到不确定的超声波:系统性审查和元分析
Vinícius Diniz Cedro Araújo1, Bianca Cardoso Lopes1, Andy Petroianu2
1Medical School, Universidade Federal de Ouro Preto, Ouro Preto, Brazil.
The American surgeon
|September 10, 2025
概括
在不确定的超声波检查 (美国) 后,仅在美国的儿科急性尾炎 (AA) 诊断途径显著降低了负尾切除率,与使用计算机断层扫描 (CT) 相比. 这种方法尽量减少儿童不必要的手术和辐射暴露.
科学领域:
- 儿科手术 儿科手术
- 诊断成像 诊断成像 诊断成像
- 基于证据的医学基于证据的医学.
背景情况:
- 在非诊断性超声波 (US) 之后,针对儿科急性尾炎 (AA) 的最佳诊断方法仍在争论中,特别是关于计算机断层扫描 (CT) 的作用.
- 高率的阴性尾切除和辐射暴露是儿童AA诊断的担忧.
研究的目的:
- 为了比较仅在美国诊断途径和在儿童初始非诊断性美国后涉及CT的途径之间的负尾切除率.
- 评估诊断策略对儿科AA不必要的手术和辐射暴露的影响.
主要方法:
- 按照PRISMA指南进行系统审查和元分析,搜索6个数据库,直到2024年7月.
- 包括纵向研究,比较美国单独与美国随后的CT途径,用于儿科AA.
- 偏差风险评估 (ROBINS-I,纽卡斯尔-太华尺度) 和证据评估的确定性 (GRADE).
- 固定效应的元分析来计算负尾切除率的聚合概率比率 (ORs).
主要成果:
- 仅在美国的途径与美国的CT途径相比,阴性尾切除的几率明显较低 (OR 0.44;95% CI 0.21-0.90;P = 0.02).
- 保护性关联在最初不确定的US (OR 0.22;95%CI 0.05-0.89;P = 0.03) 的小组中更强.
结论:
- 仅在美国的诊断途径与在非诊断的美国之后,怀疑AA的儿童的阴性尾切除率显著降低有关.
- 这些发现支持优先考虑临床再评估,并重复美国减少不必要的手术和辐射暴露.
- 由于证据的确定性较低,临床判断仍然至关重要.
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